Lepidic intrapulmonary growth of malignant mesothelioma presenting as recurrent hydropneumothorax

Our plain-English summary of Lepidic intrapulmonary growth of malignant mesothelioma presenting as recurrent hydropneumothorax, by H. Wu, G. Tino, F.H. Gannon, et al (Human Pathology, 1996).

The study

• Authors: H. Wu, G. Tino, F.H. Gannon, L.R. Kaiser, G.G. Pietra
• Journal: Human Pathology
• Published: 1996;27(9):989-92
• Type of article: Case report
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report a case of malignant mesothelioma with unusual clinical and histological findings. The patient presented with recurrent hydropneumothorax and minimal pleural thickening on chest computed tomography (CT). Histologically, the pleura was involved by the malignant mesothelioma, albeit to a limited degree. Unexpectedly, the lung parenchyma from two different lobes showed focal nests of mesothelioma cells filling the alveolar spaces and growing on the luminal surface of the alveolar septa, closely resembling the multicentric growth pattern of bronchioloalveolar adenocarcinoma. Immunohistochemical and ultrastructural studies confirmed that the pulmonary lesions were an extension of the malignant mesothelioma. This case illustrates clinically, the importance of a high index of suspicion for malignancy in older patients with unexplained recurrent hydropneumothorax; and histologically the potential of malignant mesothelioma to invade the lung at an early stage of growth.

In plain English

This article is a case report about one patient: a 69-year-old white man, a former smoker with a 60 to 70 pack-year history, who was admitted with a right hydropneumothorax (air and fluid around the lung) that had returned after an earlier chest tube. The patient was a retired engineer who had worked for many years as a naval officer on submarines, where, the article states, there may have been exposure to asbestos. Chest CT scans showed only slight pleural thickening and no dominant pleural-based mass. Biopsies taken during thoracoscopy showed malignant mesothelioma forming small nodules on the pleura. Tumor cells also grew along the alveolar walls in lung tissue from two lobes. This pattern closely resembled bronchioloalveolar carcinoma, a type of lung cancer. Staining tests and electron microscopy confirmed that the lung lesions were an extension of the mesothelioma. No asbestos bodies were found in either lung specimen. The authors concluded that the case shows the importance of a high index of suspicion for cancer in older patients with unexplained recurrent hydropneumothorax. They also concluded that it shows mesothelioma can invade the lung at an early stage of growth.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 69-year-old white man, an ex-smoker with a 60 to 70 pack-year history, admitted for evaluation of recurrent right hydropneumothorax with progressive shortness of breath on exertion; the authors are from the Hospital of University of Pennsylvania, Philadelphia
• Exposure: Possible asbestos exposure while working for many years as a naval officer on submarines; no fiber type or dose was reported
• Main results:
  • The first chest CT showed only minimal pleural thickening in the right upper lobe
  • A later contrast-enhanced CT showed slight pleural thickening and fibrous adhesions but no dominant pleural-based mass
  • Pleural biopsies showed malignant mesothelioma forming small nodules on the pleural surface and infiltrating the pleural connective tissue
  • Tumor cells grew in a lepidic pattern (along the alveolar walls) in two different lobes of the lung, closely mimicking multicentric bronchioloalveolar adenocarcinoma
  • Tumor cells were positive for cytokeratin, negative for CEA and LeuM1, and showed membranous staining for EMA, which the authors took as confirming that the lung lesion was an extension of the malignant mesothelioma
  • Electron microscopy showed features of mesothelial cells, including numerous slender surface microvilli, perinuclear bundles of cytoskeletal filaments and well-developed desmosomes
  • No asbestos bodies were found in either lung specimen
• The authors' conclusion: The authors concluded that the case illustrates, clinically, the importance of a high index of suspicion for malignancy in older patients with unexplained recurrent hydropneumothorax, and, histologically, the potential of malignant mesothelioma to invade the lung at an early stage of growth. They added that it shows the difficulty of diagnosing the disease at an early phase.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Pleural Thickening, Pleura, Parenchyma, Mesothelioma, Adenocarcinoma.

Related studies

• Recurrent hydropneumothorax as a presenting feature of malignant mesothelioma — K. Guha, D. Jones, et al. (2008)
• Diffuse epithelioid malignant mesothelioma of the pleura presenting as a hydropneumothorax and vertebral body invasion — C.A. Hinkamp, S.N. Dalal, et al. (2020)
• Malignant pleural mesothelioma presenting with a spontaneous hydropneumothorax: a report of 2 cases — H.Z. Saleh, E. Fontaine, et al. (2012)
• Simultaneous bilateral spontaneous hydropneumothorax: a rare presentation of bilateral malignant pleural mesothelioma — H.E. Fayed, V.K. Woodcock, et al. (2013)
• Diffuse intrapulmonary mesothelioma mimicking pulmonary lepidic adenocarcinoma: a rare case report and review of the literature — W. RanYue, W. ChunYan, et al. (2023)
• Recurrent hydropneumothorax: An unusual presentation for malignant pleural mesothelioma — D. DeLapp, C. Chan, et al. (2016)

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